Narrated Chapter 31 Part 1 of 3

Medication Administration Bring your Drug Guide to Class

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Objectives

Discuss the nurses role and responsibilities in medication administration. Describe the physiological mechanisms of medication action. Differentiate among different types of medication actions. Discuss developmental factors that influence pharmacokinetics. Discuss factors that influence medication actions. Discuss methods used to educate patients about prescribed medications.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Objectives

Compare and contrast the roles of the prescriber, pharmacist, and nurse in medication administration. Implement nursing actions to prevent medication errors. Describe factors to consider when choosing routes of medication administration. Calculate prescribed medication doses correctly. Discuss factors to include in assessing a patients needs for and response to medication therapy. Identify the six rights of medication administration and apply them in clinical settings. Correctly and safely prepare and administer medications.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Key Terms

Absorption, p. 567 Adverse effects, p. 569 Anaphylactic reactions, p. 569 Biological half-life, p. 570 Biotransformation, p. 568 Buccal, p. 572 Detoxify, p. 568 Idiosyncratic reaction, p. 569 Instillation, p. 572 Intraarticular, p. 572

Intracardiac, p. 572 Intraocular, p. 573 Irrigations, p. 573 Medication allergy, p. 569 Medication error, p. 582 Medication interaction, p. 569

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Key Terms

Medication reconciliation, p. 583 Metric system, p. 573 Nurse Practice Acts (NPAs), p. 566 Ophthalmic, p. 596 Peak, p. 570 Pharmacokinetics, p. 567 Polypharmacy, p. 591 Prescriptions, p. 581 Pressurized metereddose inhalers (pMDIs), p.

599 Side effects, p. 569 Sublingual, p. 571 Synergistic effect, p. 569 Therapeutic effect, p. 569 Toxic effects, p. 569 Transdermal disk, p. 572 Trough, p. 570 Verbal order, p. 577

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Assignments

Reading Assignments:

Potter (2013) Chapter 31: Medication Administration (Stop at Parenteral Administration of Medications pp. 600). In Fundamentals of nursing (8th ed., pp. 565-600). St. Louis, MO: Mosby. Morris (2010) Calculate with confidence: (you will also do this for CwC module) Chapter 10: Medication administration Chapter 11: Understanding and Interpreting Medication Orders Chapter 12: Medication Administration Records and Drug Distribution Systems Chapter 13: Reading Medication Labels
Safe medication administration (24:21) Advanced Skills Disc.
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Mosby DVD to View:

Scientific Knowledge Base

To safely and accurately administer medications, you need knowledge related to:

Legal aspects of health care Pharmacology Pharmacokinetics Life sciences Pathophysiology Human anatomy Mathematics

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Medication Legislation and Standards

Federal regulations

Pure Food and Drug Act Food and Drug Administration (FDA) MedWatch program

State and local regulation of medication Health care institutions and medication laws Medication regulations and nursing practice (Nurse Practice Acts) Refer to Box 31-1 on text p. 566 for guidelines on safe narcotic administration and control.
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Pharmacological Concepts

Drug names:

Chemicalprovides the exact description of medications composition Genericthe manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. Pharmacopeia Tradealso known as brand or proprietary name. This is the name under which a manufacturer markets the medication. Institute for Safe Medication Practices (ISMP) (www.ismp.org) and The Joint Commission (TJC) (www.jointcommission.org)
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Reading Labels: Generic Names

Given by manufacturer who develops medication One generic name Legally required on all labels Nurses need to know Dispensed less expensively than brand Common generics: morphine, atropine, phenobarbital, meperidine Look-alike, sound-alikevery different

Hydralazine vs hydroxyzine

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Reading Labels: Trade Names

Brand or Proprietary

May be many for one generic

Prominently displayed or to indicate registration of name

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Pharmacological Concepts (contd)

Classification

Effect of medication on body system Symptoms the medication relieves Medications desired effect Solid, liquid, other oral forms; topical, parenteral; forms for instillation into body cavities

Medication forms

Refer to Table 31-1 Forms of Medication on text page 567

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Reading Labels: Form

Type of med in package

Tablets, capsules, liquids, suppositories, ointments CR (controlled release), DS (double-strength) Aid in inventory control and distribution

Abbreviations or words that describe form

Bar-code symbols

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Pharmacokinetics

The study of how medications:

Enter the body Are absorbed and distributed into cells, tissues, or organs Reach their site of action Alter physiological functions Are metabolized Exit the body

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Absorption

Passage of medication molecules into the blood from the site of administration Factors that influence absorption:

Route of administration Ability to dissolve Blood flow to site of administration Body surface area Lipid solubility of medication

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Distribution

After absorption, distribution occurs within the body to tissues, organs, and specific sites of action. Distribution depends on:

Physical and chemical properties of the medication Physiology of the person taking it Circulation Membrane permeability Protein binding

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Metabolism

Medications are metabolized into a less potent or an inactive form. Biotransformation occurs under the influence of enzymes that detoxify, break down, and remove active chemicals. Most biotransformation occurs in the liver. Kidneys, blood, intestines, and lungs play a role.

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Excretion

Medications are excreted through:

Kidney Liver Bowel Lungs Exocrine glands

Chemical makeup of medication determines the organ of excretion.

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Types of Medication Action

Therapeutic effect:
Expected or predicted physiological response

Side effect:
Unavoidable secondary effect

Adverse effect:
Unintended, undesirable, often unpredictable

Toxic effect:
Accumulation of medication in the bloodstream

Idiosyncratic reaction:
Over-reaction or underreaction or different reaction from normal

Allergic reaction:
Unpredictable response to a medication Table 31-2
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Allergy Identification

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Medication Interactions

Occur when one medication modifies the action of another A synergistic effect occurs when the combined effect of two medications is greater than the effect of the medications given separately.

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Therapeutic Range

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Medication Dose Responses Refer to Table 31-4

Onset:
Time it takes for a medication to produce a response

Peak:
Time at which a medication reaches its highest effective concentration

Trough:
Minimum blood serum concentration before next scheduled dose

Duration:
Time medication takes to produce greatest result

Plateau:
Point at which blood serum concentration is reached and maintained

Biological half-life:
Time for serum medication concentration to be halved
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Routes of Administration
Table 31-5 on text p. 571 presents factors influencing administration routes.
Oral Sublingual, buccal Topical Direct, body cavity Inhalation Parenteral ID, Sub-Q, IM, IV (epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial) Intraocular

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Oral Route
Sublingual Buccal

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Endotracheal Route

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Systems of Medication Measurement

Require the ability to compute medication doses accurately and measure medications correctly Metric system (0 before the decimal only)

Most logically organized Meter, liter, gram

Household system

Most familiar to individuals Disadvantage: inaccuracy

Solution
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Metric Specifics

Gram = g or gm Liter = l or L Use lowercase letters for abbreviations for other units:

Milligram = mg Milliliter = mL

Convert fractions to decimals:

500 mg or 0.5 g, but NOT g 10 mL or 0.01 L, but NOT 1/100 L

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Nursing Knowledge Base

Safe administration is imperative. Nursing process provides a framework for medication administration. Clinical calculations must be handled without error.

Conversions within and between systems Dose calculations Pediatric calculations require special caution.

Box 31-2 Evidence-Based Practice: Reducing Errors During Medication Administration

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Dose Calculation Methods

Verify medication calculations with another nurse to ensure accuracy. The ratio and proportion method

Example: 1:2 = 4:8

Formula method

Dose ordered Amount on hand = Amount to Dose on hand administer

Dimensional analysis

Factor-label or unit factor method

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